Scottish Doctor, author, speaker, sceptic

The state of the NHS today

I still do work for the National Health Service (NHS), although not full time. Over the years, and especially the last few years, it has become an increasingly depressing, target driven, soulless place. When I re-read 1984 recently, virtually every page resonated with the type of management nonsense that rains down upon us each day. Particularly the way that language is distorted into meaningless ‘party’ slogans.

The more we are told that our healthcare trust is ‘meeting and exceeding’ targets, the more the word ‘doubleplusgood’ springs to mind, and I also know that we are, clearly, in big trouble. The greater the trumpet blast of triumphal news, the worse that things become. War is Peace, Failure is Success, Lies are Truth.

One thing that particularly sticks in my craw, are the pictures of happy staff members that adorn various PR brochures. The production of which seems immune from financial pressures of any kind. They are written in a distorted management language that uses thousands of words, whilst their meaning remains almost perfectly obscure.

A recent example of how dispiriting they are was encapsulated by a recent brochure I received through the post. It had a picture of two nurses on the front. They looked as if they had both won several millions pounds on the lottery. Their faces a picture of almost uncontrollable glee.

When I opened it, I found that this was a brochure informing all nurses, and doctors, that we would have to pay considerably more money into our pensions. In addition, we were going to receive a much lower pension, at a greater age, than we had been told we were getting in the past. Oh joy, oh joy.

I would have said the picture on the front cover was ironic, but NHS management do not do irony. We are continually exhorted, in a ‘Unite workers of the Soviet Union’ sort of a way, to be smiling and happy in our glorious tractor factory. A frowning worker is a worker who clearly does not love the party with sufficient fervour. A frowning workers needs re-education.

Ah yes, each year we produce more tractors to sell all around the world, with a song in our heart, and a spring in our step. Each five years we are set a new, joyous, production targets. Each year everything, we are told, gets better. The statistics tell us so. Each year, we can see with our own eyes, things are getting worse. I suppose people who do not work in the NHS may feel a certain echo of all of this in their work place.

Whilst mulling over this seemingly unstoppable drive from relying on professionals to be professionals; towards target driven, dehumanising, wearisome micro-management and meaningless jargon. I came across a post on Doctorsnet.uk. A website for UK registered doctors. It was written by a doctor A Boyle, and I thought it should be shared more widely. (I asked for, and got, his permission to do so).

What I wanted, and what I got?

I wanted to help old people
I got frailty assessments on incomplete information

I wanted to save lives from PEs*
I got VTE2 assessments

I wanted to diagnose the cause of acute confusional states
I got dementia screening on frightened old people at 3am

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76 thoughts on “The state of the NHS today”

I became misty eyed reading these sentiments. It is a sad place in which we find oursleves.

Prof Brian Cox played keyboards for the band D-Ream who sang, somewhat anthem-ically, ‘Things Can Only Get Better’.

They can. Things can get better.

But adversity stems only form one or other of two sources. Adversity may originate with nature and it’s wayward and unpredictable ways and forces. Or it may originate with man and man’s wayward and unpredictable farces.

Man-made ‘bad’ arises when we do harm to each other, and it arises when we treat nature with a lack of regard for her better ways and ‘capitals’. Bad is the only reasonable outcome if we abuse nature.

We cannot overcome the forces of nature that can result in ‘bad’, not with ease, but we can prepare, but intervention in effects we could term man-made-bad is simple; cease doing whatever it is that is resulting in man-made-bad.

Things can get better, but ‘we’ have to conspire to make the changes that will make things better. To prove Prof Cox correct we have to grasp the reins and address the relationship(s) of cause and effect that make things turn out bad. There may be several. But topping the list are five. They are significant selection pressures that bear upon outcomes we’d do well to want to avoid.

#1, The level of competition that results when peoples of the world try to save for a pension via medium of exchange that systemically amounts to nothing at all times is peculiarly divisive. The choice to save for a pension exclusively in fiat currency is not a good one.

#2, The decision to fund the NHS in units of currency that becomes periodically scarce due to a) it nets to nothing, and b) the ability to sustain the supply of the necessary new money periodically and inevitably falters, means that the NHS (as presently funded) is unsustainable.

#3, The funding of the NHS need not be constrained to just one currency type if our government, in keeping with governments around the world, did not see fit to collect taxes in just one currency type. (Sweden is, or was, an exception for permitting the payment of taxes in fiat currency, that’s regular ‘money’ and/or in units of an alternative currency the WIR – and Japan began mediating some economic dealings in complementary currencies too).

#4, Democratic governments around the world see fit to collect taxes only in units of fiat currency for no reason more complicated than that members of the electorate do not see any reason to challenge this folly. None of our three leading political parties or coalition actually offer prospects of the one change that would ease the pressures, and we do not press them We do not see the potential benefits in being able to save for a pension in alternative currencies either. People have great difficulty perceiving the incremental extent to which they encourage the bad man-made eventualities that blight society.

Ultimately, and I know this will now mean something to you, the level of competition needed in order for people to save for a pension rests behind the persistence and intensity with which we are told that cholesterol is bad for us when all the while cholesterol itself is not at all atherogenic, while a little-known cholesterol derivative (oxidised cholesterol) called cholesterol triol has been demonstrated to be highly atherogenic, as has homocysteine that is indicated to be the cause of the oxidative stress that has cholesterol converted to cholestane triol.

The level of competition drives the quest for innovative and lucrative market solutions to man-made eventualities we’d do well to perceive as ‘bad’, and discourages interest in the low-input and simple low cast and side-effect free solution of eradicating the cause. Many branches of ‘science’ are now blighted and essentially propagandist. Alzheimers is the next (fictional) market opportunity.

#5: People are essentially stupid. My data set here is headed by my siblings.

Indeed, Merry Christmas, It does seem a little vacuous a concept doesn’t it.

Yes, and a Happy New Year, and am I alone in thinking those words just a bit superficial.

Raise a glass to the passing of 2013, but for gods sake lets make 2014 better, and 2015, and …

Can we see fit to resolve to conspire to make future years happier for the emerging future generations that includes the Olivers, Georges, Lukes, Edwards, Arties and Jasmines of the world, and all kids like them? (Frank, Pat, Alan; the appeal extends to you too.)

Prayer alone will not intervene in relationships of cause and effect whose principle axis is man-made.

Thank you for this article Dr K. I can’t resist adding my 2 pence-worth.
Last night I gave myself a Christmas present……I took the decision to abandon the political party I have supported all of my adult life. I now look for another way of influencing medical care in the NHS I was proud to join in 1965; can anyone advise me as to which direction to take?
My husband taught Management whilst I worked as a G grade ward sister. He was in despair at the weaknesses of his students from NHS positions, and their inability to think as ‘professionals’. Yes, they wanted to be called ‘professionals’, but their inability to take on board the concepts of ‘professionalism’ i.e. Working to a Code of Ethics based on knowing Right from Wrong, and TAKING ACTION when required, (even at risk of standing alone), was a cause of great discussion between us. And it has just got worse and worse, as the years go on. We are wingey old moaners now, and probably being accused of looking at the past through rose coloured specs.
I left the NHS when I was forced to have my Nursing Care Plans scrutinised weekly by unqualified numpties, who then gave me marks out of ten for my week’s performance. I ask you….how did that sort of time consuming activity help to care for the frail and vulnerable?
Don’t get me wrong—- I was never Super Nurse, but come on……I didn’t get my many qualifications ( I was in continuous, voluntary, education throughout my career), from the Kellogg’s box!
I learnt my ‘professionalism’ in the intense scenario of Medical Schools in the North of England in the 1960s, and it has never left me…..hence my difficulty of fitting into the ticky-box ways of the 21st Century.
Who changed it all….well..politicians I think.
Happy Christmas, everyone.

As a retired counsellor I often listened to the frustrations of clients in other professions which ran along much the same lines. It’s a worrying sign of the times, and appears to be more about politics than good practice. Would that we could change this…

I appreciate your feelings but as someone who is not in the medical world and therefore relies on the NHS (although I visit my surgery very rarely), this assessment fills me with gloom. I clicked the link and read all about your new Clinical Edge practice. It sounds fantastic – and has lots of really useful advice for free – but I live in Twickenham, not Macclesfield. I’m also one of the fortunate people who could pay for a visit to the clinic but how many Macclesfield patients could do the same, especially those who probably need it most? If your clinic was rolled out round the country, what would happen to them? (Many parallels with education, of course.) Good luck with your clinic but I just wish the NHS could be reformed along these lines instead. Please keep blogging and informing us who are not on your patch.

As a teacher, this is all too familiar. ‘Satisfactory’ schools are now failing schools; apparently no one knows how to teach anymore and have to be constantly ‘re-trained’ in the current fashion dictated by whatever bandwagon the Minister for Education sees as being politically career-enhancing. And in many schools, admin staff have proliferated, management is about croneyism and subject knowledge is side-lined. Pupils are labelled and stereotyped to make them easier to ‘measure’. Thank goodness we have the ‘underground’ of forums like this to remind us of principles and common sense.
Happy Christmas to one and all.

What a delight, doctor Kendrick (but without the Mc although a whisky drinking Scot) to read your confessional; ’tis at least pleasing to note that you have entered the ranks of society’s mature. Not quite everyone reaches this stage and, the problem is, it can be a curse and a bit scary!

Here is a piece of combined verse culled from two sources (a Master’s degree to those who recognise both origins):

“If we could see ourselves as others see us
would we not shatter it to bits
then remould it near to the heart’s desire.”

Do you ever get the feeling that you are not destined to gain the Nobel Prize? A lucky guy, indeed, who can work part-time! Any more confessionals? (You are not obliged to say anything and anything you say…)

“Indeed the Idols I have loved
so long
Have done my Credit in
Men’s Eye much Wrong
Have drowned my Honour
in a shallow Cup,
And sold my Reputation for
a Song.”

Once more, at this time of year, we think of peace and good will to all but for what purpose? When I awake in the morning I think, aw, gawd, another day as I reach for the bottle of Grants 15 year old single whisky!

Finally, to quote my favourite Bard again but not Burns nor Shakespeare but Khayyam:

An easy one at last ! Quote is from the Rubaiyyat. The Fitzgerald translation if i may be allowed to show off. You may recall I commented a couple of weeks ago with a couple of lines from it. For those somewhat down about how things are – especially you Dr Kendrick 🙂 ) -look up the stanza that starts ‘Think in the battered caravanserai….’ As I said, he was a very wise man.
And finally, a merry Christmas to all, espcially Dr K. A brilliant blog with interesting comments.
Thanks

“A recent example of how dispiriting they are was encapsulated by a recent brochure I received through the post. It had a picture of two nurses on the front. They looked as if they had both won several millions pounds on the lottery. Their faces a picture of almost uncontrollable glee.”

Thanks. I feel the same way about the diabetes brochures in the US, which invariably feature middle-aged couples preparing salads with the same uncontrollable glee or running along the beach while grinning broadly, wearing expensive exercise gear most people couldn’t afford, even if they did live close to a pristine beach. But I suppose that if the brochures showed people sobbing because they couldn’t eat chocolate cake or screaming in pain as they pricked their fingers, no one would take a brochure.

Mr Bevan set up the NHS on Stalinist lines. As older generations of doctors and nurses retired, taking their old-fashioned ideas of professional autonomy and service to patients with them, the Stalinism is more clearly exposed. I can’t see why anyone would be surprised by this. No other country has been mad enough to copy the NHS, and no wonder. Its supporters are reduced to the lunatic defence of pointing to American shambolicare and saying “at least we’re not like that”. Unsurprisingly they do not point to the systems use elsewhere among the rich countries, which probably tells you everything you need to know about the dishonesty of their arguments.

What you describe is a sort of managerialism that has crept into the public services (e.g the teaching example given above), combined with the control of emotional labour (read Arlie Hochhschild). From a right wing perspective this is perceived as communism or socialism, while the left see it as the fault of capitalism. The left/right divisions are probably not helpful here but sadly political commentary forces the debates down these roads. As a Brit, most people I know support the idea of the NHS and don’t want to lose it. The question is, how to we achieve a system that supports those who need it and those who provide it. I would be interested to hear about how other countries achieve this.

Having said that, my own experience of the NHS has been pretty good. I have a good doc who I can see within a day or two of calling. I’ve had a number of minor hospital procedures in what I considered a timely fashion, and the staff and facilities were to a good standard. Maybe I just got lucky, but there are a lot of good parts of the NHS that should be recognised. And what many outside of the UK don’t understand is that if you really want to have same day service in a private hospital you are at liberty to pay extra for that if you want to. We pay a lot in taxes to get this benefit and I guess the question is, how to we assure value for money in the way that money is spent.

Many years ago, I remember Tony Blair proudly announcing that everyone in hospital would be assigned a “named nurse”! I wondered vaguely what it could possibly mean because nurses obviously can’t be on duty all the time, and maybe they even get a chance to go on holiday!

A few years later, we went to visit someone in hospital, and above her bed was a little message holder for her named nurse – completely empty. I imagine this rule had never actually been rescinded – just lost under a mountain of similar useless ‘initiatives’.

It isn’t just the health service, some years further back, I worked in a university, and some kids set fire to some scrub just outside. I knew it would burn itself out, but I thought it was a legitimate reason to try out a fire extinguisher! The fire extinguisher (supposedly regularly tested) seemed to have prostate problems and I only succeeded in wetting my feet! I reported the problem to our safety officer – pointing out that the consequences could have been very serious if the circumstances had been different, and in due course I was told the extinguisher had been re-filled so there was nothing further to worry about!

I am going to try voting UKIP at the next election, in the hope that they can inject some common sense back into this country! Otherwise I really can’t see much hope for the place.

I am concerned not to turn this discussion into too much of a party political debate, but I would suggest you read some of UKIP’s policies before you assume that they are:

a) Extreme in any way.
b) Limited to a desire to leaving Europe.

I would characterise them as a party of traditional common sense – and we could sure use some of that nowadays! Remember, they alone came out against an attack on Syria – which possibly swayed enough MP’s to win the day in parliament. This prevented a huge escalation of the conflict, and enabled action to remove the chemical weapons.

David, in 1983 I was indoctrinated into implementing “The Nursing Process”, imported from the USA, as to how we in UK, should organise our Nursing duties. It consisted of a ‘Primary Nurse’ for each patient, substituted by a Secondary Nurse ‘ when the primary was off duty.The concept flopped.
In the 1990s, The Named Nurse idea was introduced along similar lines. The concept flopped.
By the time Tony Blair was in power, I had given up taking any notice of politicians’ and non- clinical managers’ interference with my Profession. I left at the turn of the Millennium, disgusted at the lack of support for true NHS clinical professionals. Believe me, I could write a book!!

Taking the lead from David Bailey here are a couple of more considerations.

When showering in hospital I noticed that I could reach from the shower cubicle and touch the uncovered ceiling light which was lit. On reporting the incident I was accosted by a manager from the building maintenance who wanted to know why I should be so worried; he then tried to convince me that the light was a per regulations!

On an outbound flight from the East Midlands my seat belt would not fasten so it was reported to the Stewardess who passed the buck to her senior, an attractive female, who tried to convince me that the fault was mine even though it was apparent that the clip would not fasten. Subsequently, on writing to the company’s chief engineer he checked the belt to find it was faulty and apologised. The question that arises is; is it management that is at fault or could it be the thresh-hold guardians?

Another interesting feature about public services is that a few years ago when research was done into the danger that faced the public by prisoners, it was reckoned that only 2% of the prison population represented a threat so why are there so many high security and costly establishments? Could it be to appease public fear or is it the sign that the prison officers’ union has won the battle of proving that staff have a dangerous job (yet those dangerous prisoners do get released)?

The questions that arise revolve around the three levels of perception, the first two which most understand and is that of what is said to be done and that of what is seen to be done, yet few, indeed, are able to comprehend what is actually occurring and those are the ones who are transported to Siberia.

Those human traits are not new as they are mentioned in folk lore, which, paradoxically, some think are childrens’ fairy stories! Even Machiavelli (16c) understood this human trait while today we are subjected to the machinations of the new world leaders of which Tony Blair plays his part and which the NHS is merely a symptom of today’s global political propaganda and society’s decomposition.

How many are aware that our skies are sprayed daily by chemicals and that the Boffins are actively experimenting with the planet? As the late comedian Jimmy Edwards would often say, “Wake up at the back there!” Ignorance is, indeed, bliss; now where did I put that whisky bottle?

Speaking as a patient I thoroughly dislike the target driven culture which GPs seem to be obliged to follow with everyone who steps over the surgery threshold these days. I have found myself subjected (by command not invitation) to tests which I don’t need in order that boxes can be ticked. More seriously, I know for certain that the numbers in the boxes for blood pressure and cholesterol are wrong, but heyho, there’s a number in the box so that’s all that matters isn’t it?!!! Be very wary of population health reports which you may read – they are likely to be grossly inaccurate! As one never sees the same doctor twice, this is even more scary. Ask for explanations? Not likely! My doctor, who is from overseas, appears incapable of explanation and has quite the worst bedside manner of any doctor I’ve ever met.

It seems a patient can do nothing in the face of such authoritarianism and I am fed up with NHS Primary Care.

We here is the old US of A now have our own version of socialistic medicine and they call it affectionately “Obamacare”. Of course many folks have lost their private healthcare their proud employers at one time could afford. So, for now, we are invited to “sign up” for the socialistic piece of rubbish that not even its namesake understands. I think what it really means is “Yes, dear Americans, many more taxes”. Our far left president seems to think whether you walk right up through the front door or creep inside through the back door, the fire is still as warm inside. Indeed it is…at least for the stupid, American hating left wingers. It is, after all is said and done, for many Americans who are already strapped (especially those self employed), yet another tax that no one can afford or understand. I hope it fails miserably. I hope the young healthy people stand up to them and rush to busy emergency rooms when they need healthcare, then file chapter 13 when the hospital comes calling for payment of their bills. He is already lying through his teeth while computer effort after computer effort fails miserably to “enroll those lucky Americans” to purchase and pay for healthcare they don’t even need. It is a sad day…one my own pediatrician told me about when I was but a child myself. He warned me. I thought the old man was a fool. He was, in fact, right on target. I loved him like he was my own father. He made house calls, nursed us back to health with kindness and tedious instruction and always told us we could do our best in life and in health. He was right. We spoiled Americans never thought the day would come when our entire medical system would be turned over to those who hate it the most and who have given the least back to our society. They make me ill. I will not give up the fight. I hope I live to see it repealed. Americans are fed up…and they ought to be!!!!!

I don’t think totalitarianism is specifically socialist in nature. It is all about power, who has it, who has it not. Bureaucracy is just part of a system of strangling freedom, and ensuring all people must do your bidding. In 1984 I don’t think you could say that the party was right wing, or left wing. They just wanted power and used all mechanisms to ensure it was ruthlessly enforced.

Dr K your response to Mary is spot on.
Mary’s concept of benevolent employers was prevalent in UK too, e.g. Titus Salt and Robert Owen and Cadbury …to name a few.
But we moved on in 1948, realising that many folks needing access to health provision were excluded due to lack of finances; possibly in employment, but not lucky enough have medical care provided by their employer.
Good on Mary and her family that they have the where with all to get the care they indulge in. I detest the concept of “I’m alright Jack” that comes across in Mary’s response, and so sad that at this time of “goodwill to all men”, we still have people with such a mind set.
Let us not throw the baby out with the bath water…..we need to improve our NHS, not abandon it. I simply want to know how we should go about sharing the facilities out according to need, without the worry of paying up front.
Or am I just deluded that such a Utopian ideal is my adult form of Santa Claus?

Obviously our systems are quite different as are our views of government. I happen to thank God for the healthcare my mother gets at her age. I also thank God my father saved enough money such that she can afford a secondary healthcare policy to keep her from losing everything he worked so hard for. And…by the way, if her healthcare costs exceed that which is provided by both Medicaire and her “private” healthcare, they can and will take our family home. And Dr. K…will someone please tell Jennifer there is no Santa Claus?

The tragedy is that the NHS was – and to a great extent still is – an amazing institution. I mean people aren’t put into debt paying for health care for themselves or their families. Anyone can go and visit their doctor absolutely free, and if they need drugs, the cost is moderate and there are various exemptions. The big problem is that politicians have endlessly meddled with the system, more or less as a displacement activity!

I hope ‘Obama care’ ultimately gives US citizens a health service something like the one we still enjoy here.

Yes, not so much about right v left anymore. I think it is all about responsibility which has been taken out of society. The insurance companies do this actually. By insuring away a risk you are putting responsibility with a hidden, remote entity.

So we no longer have individuals actually pulling the strings in our own local communities (think local bank manager being replaced by a centralised computer and small controlling sub group).

Going into Europe in our gradual way since the 1970’s is also part of this problem.

UKIP definitely has some better arguments to returning our society to a more responsible way of living.

Well said John and I do agree very much. However, in the U.S. Congress it is very much about division along our party lines and there is not much cooperation between them. It appears they care more about pointing fingers than listening to the people and carrying out their wishes. Your point was well taken and you said it like a gentleman.

I’m extremely disappointed to see a strong political tone creeping (creeping? – more like rushing) into this blog. I’ve enjoyed and learnt much from Dr Kendrick’s posts and many of the comments/replies that have been made on the health topics that have been raised. Inevitably we all have differing political views and they will colour our perception of the quality of care we get but voicing them here, in my opinion, detracts from the the usefulness and attraction of the site.

The problems that Dr Kendrick described in the NHS, are undoubtedly due to the changes made by politicians, so I can’t see how and discussion can omit politics completely. Even that sad state of affairs in which drug companies exert so much control, is ultimately the consequence of political decisions.

David, no doubt the sad state of affairs where drug companies undo harm is going to involve strong political decisions as well. And that is going to be up to the people to let their voices be heard via the politicians who have voted them into office!!!! Those decisions may not come about overnight. Recall the huge influence and lobby of the American tobacco industry. It was a hard fought battle, however, those who believed them to be harmful refused to be controlled and made sure that the truth eventually prevailed. Guess what? It worked. And since American democracy was formed, the three branches of government were formed to “keep the other in check”. Flawed though it be, it works. The FDA for the most part works as it should. We cannot throw the baby out with the bath water. They do their jobs. Some fights take longer, that’s all. And you will always have the criminal mentality wherever you go. No industry can exist without politics…not one. That is how things get done. You win some, you lose some. However, you never give up fighting the good fight.

I think a discussion on the different ways that healthcare provision is funded, and run, in different countries is a matter of particular importance to humanity. Personally, I find it amazing that people in the US feel so strongly – in favour – of a healthcare system that does so extraordinarlily poorly on all measurable healthcare outcomes. More amazing as they spend about twice the GDP of any other country. But, hey, I have found that strongly held views are pretty strongly held.

Politics?
Whether we like it or not…it is the be all and end all of every aspect of life, and we can choose to participate or not. What we cannot do is escape its impact.
As a 5 year old in 1952, I asked my Daddy who had bought the bandages stacked up in the treatment room where I was taken to for emergency treatment. Being a savvy child from a very poor background, I was fully aware that money was tight, so the question was relevant to me. So, I did not need to question who paid for the sight saving operation I needed the following year.
Answer:- NHS via taxation.
As an expectant young mother, I asked my mam how she had afforded to give birth to her 3 children, pre NHS facilities.
Answer:- charity, and the good will of friends and family. A bit hitty-missy really.
As a professional in the NHS, I questioned how a particular patient landed in a particular bed, in a particular ward, whilst other needy individuals seemed to be left to their own devices.
Answer:- it had been shown that over the years, the NHS was over whelmingly being used by the articulate middle class. The voiceless, poor and needy were beginning to be excluded!
We can bury our heads in the sand and ignore this, but only political intervention can even things out, because we never know what is round the corner. Some things are for certain; I like not worrying about the availability/price of bandages, I like the thought that my grandchildren will have access to safe obstetrics when they have no savings, and, when the time comes, I trust that there will be a modicom of state care available, should aged incapacity put me into a position of need when my meagre NHS pension ( £59 per month), fails to pay for a nursing home.
8 years ago, I was dismayed to be in a meeting in Leeds, filled with high ranking politicians and civil servants, who, when I explained that my NHS pension was so low, and my state pension top-up amounted to 29p per week, I was dismissed as being untruthful! They were so removed from reality, that they would accuse me of lying, rather than face the facts.
But only political intervention can ensure fairness for all, and my question remains – How do we do this?
My answer? Taxation—( the membership fee of a civilised nation), —being managed honestly and conscientiously by elected politicians. We have no other way.
I rest my case.

I take your point. However, I’m confident that the situation I describe arose from financial inducements offered to GPs by the government of the day in the early 1990s. In other words, simplistically-minded politicians telling professionals how to do their job. Some of the worst events in recent history generally have arisen through misplaced idealism on somebody’s part. Let the politicians butt out and let the professionals get on with their jobs without interference.

That is my point precisely, dearieme!!!! Why call it something else when it has been available for years? It is just another tax!! Not only do we have medicare and medicaide (and our veterens benefits), we have section 8 subsidized housing, cell phones free of charge, child care, vocational rehabilitation, etc., etc, etc…and the beat goes on. It is a tax. Plain and simple. The very people who pushed for and advocated “Obamacare” or Hilary Clinton care also demanded that the banks ease their restrictions on home ownership. What happened? People who showed no sense of responsibility with regard to their credit scores could now own a home they could not afford or care about. They walked away from them. Let the chips fall where they may and they did. The bottom fell out of the housing market and the banks were flooded with homes that they did not really want to or could afford to own. The economic crisis of 2008 ruined many people and their hard earned savings plans. Those who did work hard to get and maintain a home lost much of their homes values. Yes, the system is in shambles, but not for all the reasons you think. It is way more complicated. Gee…hope they are happy now. It is the Robin Hood mentality in power. It is just their time exaggerated. The hard working middle class will suffer the most. But, hey wait…maybe they are trying to get rid of them too. Oh, I see where this is going. Now, I have said what I think and my political views are pretty apparent. That does not mean I think there is no room for these programs…it is just that when you give someone something they did not work for…they tend to not take care of it.

Yes Mary, I would say your political views are pretty apparent. As a British citizen married to an American citizen, I have always understood the NHS was funded by our National Insurance contributions so that all could receive proper health care. For all its faults it appears to me that ‘Obama Care’ is an attempt to achieve something in that direction. I know there are strong feelings both for and against, and I have certainly heard them expressed in the media.

For me, what is currently wrong with the NHS, as in other government run organizations, is over management from outside, which raises costs and wastes the time of the professionals actually doing the job.

Thanks for enlightening me Celia. It just appears that we already have so many opportunities for those in need to obtain decent healthcare, that such drastic measures as those in Obamacare scare citizens who work so hard for what they have. Americans are frightened that more and more of their obligations are to the government and that the government seeks to take all choice away from it citizens. These are just not good times for America in general. Even my clients on some sort of social welfare are frightened. Now, that tells me something.

I wonder when these institutions would understand that a good state of health is different from what it is being promoted for more than 40 years.
I wonder how long it will take for the good change to propagate at all levels.

Ok, agreed, it’s all politics and Lorna, Jo and Jennifer have my vote in this discussion. I guess I naively thought that if we followed Dr K’s blog, we’d all be like-minded! We in the UK can’t imagine the worry that Mary’s family suffers making sure they have primary and secondary healthcare insurance cover and then possibly losing their house if it all goes wrong. It appears that ‘socialistic’ medical care has been very poorly explained in the US. I simply can’t believe that anyone who understands how healthcare works in Europe could vote against it. The NHS is obviously not perfect and from what you healthcare professionals are saying here, it badly needs some reforms especially to the stupid, mindless bureaucracy but let’s get behind these and not abandon the system. Like Jo, my own personal experience of the NHS has been good but I’m lucky and have good health.

I have worked for 30 years in the US system and 4 in Australia (currently). The US provides most of the driving force for medical innovations paid for by the American public, so that the UK and other socilaized systems can cherry pick what they feel they like, without the massive expenditure of time, talent and dollars. The ability to get services quickly with virtually no waiting lists, in hopitals that are not falling apart, with ward closures due to lack of staff, which is rife in Australia, is a striking contrast. People view “free” as the important feature but it means little if you can’t get the care in a timely fashion. Our ERs in Australia are poorly equipped, overloaded: anyone with an interest in stunning design should see the layout of Renown, the premier hospital system in Reno, Nevada. Others like it are also in other parts of the US.

Having served as a medical director in one of Adelaide’s main hospitals, all I can say is that it was an awful experience.
Does the US system need fixing- Yes! Like all others it has not been prefect but, dear folks, most Americans would never put up with the inefficiencies and poorly equipped facilities that exist in Australia- sadly, they may be about to experience this if Obomacare is not thoroughly revised. The fix for the US system is easy but since it would involve insurance company and hospital financing changes, iyt is not likely to happen. It is far easier to make “greedy” doctors work harder for less and call it “superb” care.

You are obviously in a much better position to judge these things than I am so I have to bow to your superior understanding and experience but what happens to the people who are not covered by insurance in Reno, Nevada? Do they have access to the same superb facilities? I hope they do, of course, but when I read health forums etc, a lot of Americans seem to be constantly worrying about how they’re going to manage to pay for their care. Someone else commented here about the unnecessary tests that are common in some better-resourced systems, France for example. Is it possible that some of the medical innovations paid for by the American public are not actually so good for us – like statins? In the excellent advice on the website of his new private GP clinic (http://clinicaledgehealthcare.co.uk/) the examples of healthy, long life come from poor, simple communities like Ikaria in Greece. OK it’s pie in the sky to think that we can all live like Ikarians but we could try some of the suggestions for improving our lifestyle and maybe we wouldn’t need so much high-tech medicine – or at any rate it could be directed at the most needy and emergencies. As I say, I’m ‘only’ a (potential) patient so my views are completely uninformed except for my own very limited experience.

Dr Willcourt,
Your response has really got my goat tonight, and I am appalled that you have got so far in your career believing that we in UK have cherry-picked stuff from US research!!! A long list of beneficial treatments have been developed, and passed on freely, outside the US.
People with sufficient funds can always jump the queue, especially if they do not like the facilities on offer in the NHS. I have experienced working in private and public hospitals. Believe me…..the glossy furnishings, and a posh french waiter serving the meals is of nothing in comparison to delivery of medical care.
And don’t even go along the path of ‘for free’. This is a total mis-interpretation of the NHS in UK……the concept is , and always has been….”FREE at the point of NEED”, and that means we pay our TAXES/ and national insurance so that professional care is available when required. I have had this principle reinforced by experience since 1965. I want the best for the people who need care, even those who have not yet managed to pay into the system e.g. Youngsters looking for employment, or those so unable to work due to disability, or even the downright lazy.
From a humanitarian point if view, I believe all people in society deserve care when needed. In my training in the NHS, levels of care were non- negotiable between rich and poor.
I apologise to Dr Kendrick for this rant, and fully understand it you decide not to post my response. I am livid.

Brilliant Dr. Willcourt! I could not agree more. We Americans (rich and poor alike) are spoiled. While the doctors and hospitals in America feed at the trough of greed by overcharging for services, charging for services they did not provide (it happens all the time), those who have been accustomed to decent healthcare (rich and poor alike), are those who suffer the most. I don’t understand Obamacare any more than the president himself. It is a matter of fixing something that is NOT BROKEN. We have always had Medicaide, Medicare, free clinics (non profit subsidized by individual donations), and free clinics and hospitals that anyone without healthcare (Medicaire and Medicaide included) can easily walk into and receive care. The number one complaint is that they had to wait several hours to see a doctor. Well, so do many “paying” customers. These are not “shabby” facilities either. Many are state of the art teaching facilities. So, I just do not get it at all. It is a hot mess. The insurance companies will make their money, so will American doctors. Neither will miss a beat as Obamacare could not survive without their cooperation. It is again, the individual taxpayers who suffer the most and the small businesses as well. The vast majority of businesses in the US are considered “small”. Those businesses are the very backbone of our American economy. They provide the jobs which in turn churn out the taxes that pay for our wonderful American lifestyle. It is not a matter of the have vs. the have nots. Not just rich people vote for Republicans. And those who vote for Democrats are not only the poor. Just look at the Hollywood elite. If you are a Republican in Hollywood, you fall in the category of someone to be ridiculed and ostracized. People in America vote for this one or that one based on their conscience and belief systems. One of the biggest problems (if not the biggest) in the American Healthcare systems is corruption. It is a forgone conclusion that when you get a copy of your medical bill (and closely review it) from a hospital, it is full of charges three times what they should be, or full of charges for services you did not receive. Insurance companies have whole departments dedicated to catching these “over charges”. As far a Medicaire fraud, it has been rampant for years. The number of doctors who made their living defrauding the government would turn your stomach and have made it difficult for those populations who depend on these services. The proponents of Obamacare say all people, not just those who can afford to pay their insurance premiums, should have access to healthcare. Well, guess what? It has always been there…so what are we fixing?

“The US provides most of the driving force for medical innovations paid for by the American public, so that the UK and other socilaized systems can cherry pick what they feel they like”. Maybe not. The economics blogger Tyler Cowen last year named five (IIRC) great medical treatment advances of recent years, all of which were American. Or so he said, but a commenter did a bit of googling and found that a substantial part of their invention or development was not American.

Much of what is said is partially true; obviously there are cultures and subcultures and whenever one moves from one to another some adapt and some don’t and those who do not cause disharmony. It is the same with responsibility, some use it in a supportive manner and others use it as the weapon of coercion. With the influx of foreign nationals into the UK its culture, as is currently recognised, is being compelled to adapt and this change is more connected to expediency than to any other feature. Australia and the US, which are almost continental in size, have been in a state of flux for around three centuries or more when we Europeans, like the Spanish Conquistadors, almost entirely eliminated the natives but, today, the reverse is in progress and with it there is the machinations of the new world order and its concept of a global village and world domination under the disguise of the The Council on Foreign Relations and the United Nations. While we are squabbling among ourselves, on inconsequential matters, what needs to be addressed is the spectre that is looming ahead of us. The problem with politics is what the late Sir Robin Day said about MPs when he described them as being the here today gone tomorrow brigade, a very apt description but what is the alternative? Do we live for the moment by supporting allopathic medicine (and, incidentally, the NWO) or do we fight to restore natural medicine and preserve democracy (if such a feature actually exists)?

The problem with debates between Americans and people from countries that provide national healthcare services is that they come from different belief systems. In the US individualism is valued and what is important is that if you can afford it (or afford the best insurance policy) you can buy the best. If you can’t afford it, then it’s your fault for being poor or not working hard enough. In countries which value universal health care, they view affordable health care as a human right regardless of whether you are rich or poor. When people who hold such disparate beliefs debate these issues they never really understand how the other half thinks and so debate is not particularly helpful for either side, it seems to me. I’ve given up discussing health care with Americans. As already seen in this thread, some Americans think that those who support the NHS are extremists and lunatics! LOL – see I prove my point.

I’d be interested to hear about other nationalised healthcare provision. There the starting point is, we should be doing it. The question being, what is the best way forward.

Apologies if I offended any Americans in favour of universal health care!

Well put, Jo! I agree would be interesting to hear about other systems. Doesn’t France have one of the best? Judged by cost? Mortality? Or?? What about Scandinavia? (I’m off to France now so dipping out of this debate for a few days. Happy discussions & Happy New Year! May we all keep as healthy as poss in 2014.)

Thank you.
I’m one of those lunatics who believe that access to healthcare is a human right, and I think it’s a privilege to live in a country that offers a (partly) “socialist” healthcare system (Germany). Employees may opt out of the compulsory public health insurance system when their annual wages exceed a certain level (appr. 54,000 euros in 2014) and get private health insurance instead. My husband and I decided to remain in the state-run system for practical reasons: private health insurance becomes very expensive in old age; doctors regard privately insured patients as cash-cows which leads to over-diagnosis and over-treatment; and for principal reasons: liberté, FRATERNITÉ, egalité.

As to Dr Kendrick’s grievance: I think there is an ever growing industry sector that tries to feed off state-run healthcare systems in Germany and elsewhere: business consultancy companies, IT companies, and others. E.g. the German public health insurance system paid more than one billion euros for the development of an electronic patient card that doesn’t work. A feast for IT companies and a huge bill for the public health insurance system.

By the way, I read Dr Kendrick’s Cholesterol Con only recently and was pleased to see that he cites Michael Marmot’s research. What a pleasant surprise.

The very notion of a “human right” is silly. Man is a social animal, so there are “civil rights”. Whether healthcare should be a civil right, and if so under what constraints, is a topic suitable for debate, but “human right” – phooey!

Arriving by accident via a link, I thought all “doctors” had gone, it’s refreshing to find there are a few left, well done Dr Kendrick.
As to the horror bringing politics into the situation, in a nationalised health service like ours they are inextrcably linked. If you want any change in it you must also change the other. We don’t change the politics though do we, they all use it as a threatening or promising instrument and we fall for it every time.
Big pharma lobbies government to use thier product on a promise of a small investment in the product will reduce their overall liability. The govermnent don’t actually “care” about me or anyone else, just how much you may cost.
The government in it’s never ending desire to reduce it’s liability has achieved the opposite, by instilling fear into the populace it has created a need that it can’t service.
I want to consult a doctor when I’m unwell, I don’t want to be summoned to facilitate his next box ticking and bonus opportunity. If doctors sugeries and the NHS were not grossly overpopulated with the worried well this would be a distinct possibility.
High blood pressure and cholesterol “may” shorten your lifespan, worrying about it “certainly” will.
If you have any concerns about the issues raised in this post please consult your GP.

The problem for some patients like myself is that NHS GPs are so busy with targets and tick boxes that they can’t provide the sort of care that we want and need. I can understand why GPs feel pressurised by the government to follow this tick box culture but it is destroying the doctor patient relationship. Some of us feel badly let down by a system that puts targets, tick boxes and test results way ahead of patients’ health and how they feel. I do not know if this is similar in other countries and medical systems.

It is not as if Americans or any of us live in a totally individualistic
society.

The big reason for adding health care to that list, is that a person’s need for health care varies so much – largely through no fault of their own. Even insurance policies don’t really solve the problem because those with health problems also pay more. Also, everybody gains if people are kept healthy – infectious diseases are less likely to spread, those with mental problems are treated rather than ending up on the streets, There is pressure to keep medicine affordable, etc.

If only Republican Americans could reaslise that we are all on a continuum between total individualism and ‘socialism’ – the extremes are uninhabitable!

Yes, David Bailey, your response it that of a lovely human being. My problem is in calmly debating the question of utopian health care for all! The signs of a civilised society should be than no-one inhabits those extremes. Those opposing my aim may suggest that absolute fairness in some way detracts from their own freedom. My answer is that those wanting more than his brother’s share, should look closely at their conscience.
I want better for all, based on need, not more for the few based on wealth. Simple objective….but we are unlikely to achieve this whilst some people feel they deserve a greater entitlement than their neighbour.
A happy and healthy new year to all.

Makes me sad to see Federalists’ opinions. The State only sponsors what the private sector invents. The things that you quoted about government doing, were not invented by government. Indeed, it is the citizenry that allows the governement to perform these tasks at the request of the citizenry… or that is how it should be. Picking on Republicans is asinine. I could argue that Democrats love to punish initiative, love to blame the rich for all the ills of society and that they believe in a thing called social justice to solve society’s problems. Oh wait! They do!!!

To argue that Republicans want people to be unhealthy is so absurd that I have no idea where to go with rebutting that. ALL Americans want to be healthy and to have a means to achieve that. It’s the “getting there” that differs. I now live in a Socialst (Communist) system in Australia and it is certainly lacking. Let me see– who perfected all the tools that I use. Oh, yes, Americans had something to do with it. NOW how could that be? I am SOOOOOO perplexed!!!

Oh Willcourt, you are right on with your comments. The poor or those who can’t afford private insurance have always been able to obtain good healthcare of one sort or another. I also believe that there are two reasons so many “unnecessary testing” is done. First is the bottom line. It is about money, meeting quotas, and overbilling the insurance companies and medical entitlement programs. When I go to my first class clinic, I never wait longer than 15 minutes (I live in a small town and that clinic runs like a well oiled machine). In and out, take your diagnosis to the receptionist so she can arrange blood work or whatever they think you may need. If you do not stop by the receptionist on your way out, you are in trouble. Cover yourself by never leaving without a script in hand. The second reason and I believe most importantly is that Americans are sue crazy in the worst way. If a doctor looks at you cross-eyed, they will find a reason to sue you. And…you will get your settlement. It is almost as though they have to protect themselves from themselves. The liability insurance for doctors and clinics is outrageously expensive. It is no wonder they are trying to get people in and out. When people were getting letters left and right saying they had lost their insurance, they tried to sign up for Obamacare. Six people were signed up on the first day. Now, we have known about Obamacare since 2010. It is not like they did not know what was coming!!! My clinic was cramming in the “paying” patients like there was no tomorrow. They were doing testing well into the night hours. Our clinic always closed at 5:pm. So, they jumped at the chance to bill any and everyone scheduling testing in the evening. They communicate through a portal so there is a paper trail. You can view your testing, blood work and any messages from your treating GP. Likewise, we can chat with them if something is amiss and they set up an appointment and let you know through your portal. They don’t ask if it is a good time for you. Actually, it is good for us depending on whether you have been harmed in some way. I believe in my heart that much of the medical costs in this country are no doubt due to statin overuse. Statin poisoning has permeated medicine hurting more than they help. Practically everyone I know is prescribed statins and they are falling apart, with no idea as to why they are so sick and have so much pain and fatigue. The clinics and hospitals are freaking out that they will have their institutions fall apart due to lack of funds to support this huge hospital chain/clinic that has taken over the world in my county. And btw, when I go to clinic, I never know who has regular insurance they pay for or someone who is on one medical entitlement or another. So, unless something is done, they are going to have to come up with another way to ease the strain on the national deficit. That is what Obamacare is…it is a tax and a punishment to those who take initiative, work hard, and earn a decent or above average wage. Under Mr. Obama’s rule, there are more people on some sort of government assistance programs than ever before. They advocate it in fact so that they can control them. They are so indebted to the government that they have become slaves to a system. But, it is still never enough. They enslave themselves and are angry. The simple fact is that when you get things you have never worked for and have an entitlement mentality, you have no power left. The prisoner never loves the warden. National Democrats love to tax people, especially the rich. They hate them unless they are the type of rich to fill their pockets with campaign contributions. They call them “war chests”. Gee, I wonder why.

Republicans are justifiably suspicious of Global Warming aka Climate Change, so it isn’t as though one side is right about everything in American politics.

Perhaps it would be better if your country brought in universal health care state by state – rather as it seems to be legalising cannabis state by state! That way, people can see different systems running side by side.

I think a lot of people over here were shocked to hear some of the extremely negative statements about the NHS coming from Republican politicians! It sounded more like propaganda than any sane assessment of what we have here.

I remember overhearing a group of Americans in a cafe in Colorado discussing their symptoms. One said that she couldn’t afford to go to a doctor, so they simply speculated about what might be wrong. Multiplied up, that makes for a lot of people leaving problems that need treatment, and a lot more agonising over symptoms that would turn out to be trivial. In the UK, a visit to a GP is free.

Dr Willcourt, your assertion that Australia is communist/socialist is simply not true and displays some ignorance of our political system. Australia is capitalist democracy with a social conscience. Since 1975 we have had universal healthcare, a policy supported by most Australians. We also have the option to purchase private health insurance if we desire. Health Insurance rates are also regulated by the government. I recently had bi-lateral knee replacements paid for by my health insurance so I did not have to wait and I could choose my surgeon. If my fellow Australians who are less financially fortunate than me require this surgery I do not begrudge paying extra taxes to cover those individuals who will have knee replacements through the public system. A relative was recently diagnosed with advanced breast cancer and as she has no health insurance, she was given world class immediate care at no personal cost. It is a sign of a mature society when those less fortunate can receive the healthcare they require when it is needed. No individual should be penalised simply by an accident of birth. Australia has many fine hospitals and a 4 year stint in a hospital in Adelaide does not an expert make. Of course, our health system does have problems but I venture to say that poor uninsured Australians receive medical care when needed at no cost and of a quality that is at least as good or better than that available to them in the USA. If you haven’t seen the excellent documentary made by Michael Moore, Sicko, about the appalling state of US healthcare for poor people. you should watch it. It makes me proud to be an Australian. And I would like to mention Howard Florey and Barry Marshall (both Nobel Prize winners) who hail from Adelaide and Perth respectively. They are Australians and have contributed enormously to the good health of the world.

One of your points is probably a straw man; I have never met anyone, ever, who did not think that dealing with infectious diseases was best done collectively. I can think of examples of people exploiting the system shamelessly – e.g. avoiding such risks as might attend the vaccination of their own precious snowflake in order to free ride on the vaccination of other children. Guardian readers, probably.

I don’t understand your point – those vaccinated against a disease are not at risk from anybody else, whether or not those others have been vaccinated. Everyone has to be allowed to make their own choices. And be careful, Dr Kendrick may be a Guardian reader.

# Robin
I don’t think it is helpful to claim superiority in medical innovation for any one country. I have a copy of Dr James Le Fanu’s book ‘ The Rise and Fall of Modern Medicine’ in front of me and he cites 12 ‘Definitive Moments in Medical Br’eak-through in the 20th Century. For example: The Copenhagen Polio Epidemic and the Birth of Intensive Care; The Australian doctor, Barry Marshall and the discovery of helicobacter and the cause of the pepetic ulcer Peter Medawar’s contribution to tjhe understanding of the immune system’s role in kidney transplantation (born in Barazil to a Lebansese father and English mother) . It is inspiring not only to read of these medical achievements but also to know that they are not bound by any one culture or political system.

Not correct: Barry Marshall is an Australian. (See above too, the comment from Margaret). If you look up the names and backgrounds of the Nobel Prize, winners, many breakthroughs are a result of collaboration and/or the evolution of treatments from a number of multi-national sources. The point made by Dr Willcourt was: ‘Who invented all the tools that I use (as a doctor)…Americans’. That clearly is not accurate as any dip into the history of medical innovation will show.
Personally, I find it inspiring to know that the sources the medicine we use today is from such a wide spectrum.

Interesting how people interpret things. As an Australian, who has worked a long time in the US, where patient access and quality of care was superb for the most part, I shall say again: the system in Australia is broken, many consultants are not up to date, and the arrogance they exhibit would lead them out the front door if they were in a US practice.

Dr xxx (rising up from behind his desk): “”Excuse me Madam, but I am Mr xxx, not doctor! Please don’t forget that. I worked hard for this title….”

Patient flustered. Registrars and students, looking at the floor, embarrassed.

re: the sorry state of the NHS.
Here is an article describing the horrors of “free” medicine. The link to the full article follows.

“How poor is access to care in socialized systems like the NHS? Access problems are so widespread that the government was compelled to issue England’s 2010 “NHS Constitution” in which it was declared that no patient should wait beyond 18 weeks for treatment.

It is noteworthy enough that the UK government felt so much pressure from the systemic failures of its NHS that they were forced to issue “rights” to patients about receiving medical care.”

Well I can tell repulsive stories too!!! But mine occurred in the private sector, so here’s one to be going on with, Robin.
I agreed to work in a private hospital short term, whilst I was completing the sale of my house to move out of the area…..my story goes like this…..
Casually dressed, snobby, pompous Consultant yells to me at 9am…
.”so why the H…..don’t your incompetent nurses have the facts at their finger tips ready for me? ( my aside…”because….you must know I am GOD”)
Me, as a strong willed, middle aged, dyed in the wool NHS Staff Nurse….”But they have…..you just haven’t listened to their explanation”.
His retort, with unacceptable quantity of expletives….” Out of my way, woman, don’t bring your NHS values here, we can do without them!” (my aside “oh, I do look good in front of my patient, tearing a strip off a measly, lowly nurse”)
So, knowing from my excellent NHS background how to deal with such rudeness, I took him aside, and said I would not put up with his unprofessional conduct, and would report him, and he retorted that he would report me! Aww, didums.
So, I complained to the “matron”….( Yes they still existed in the private sector then, more’s the pity.)
Her response? “don’t expect to be treated here the same as in your previous NHS placements……you must understand, these consultants are doing this work in their spare time, it is their hobby whilst away from the constraints imposed on them in NHS premises……they come here to let their hair down, and if that means they can vent their frustrations out on you, then that’s the way it goes! There is no rule against swearing here, so, put up or shut up!” I did neither…..I resigned.
Would you like some more tales Robin, because I have plenty? Whenever such outbursts occurred in NHS, as happened from time to time, due to pressure of work etc etc, I managed them completely on my own, face to face, and the matter was over and done with….because they knew they were in the wrong, and an apology was made, and accepted, even if it did take a few days for the storm to subside.
And by the way…..I have spoken to some of the most eminent doctors in NHS, who told me that if they or their relative needed serious treatment, there was no way on god’s earth they would have it done in a private hospital!

Dr Kendrick cannot provide individual patient advice over the Internet. UK General Medical Council regulations are clear that to do so would be a breach of medical standards that could result in disciplinary proceedings.

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